Papillary thyroid cancer metastasis to bone

Vol 116 No 4 (2012): The Medical-Surgical Journal

Reprezinta cresterea de volum a glandei tiroide, prin prezenta unor noduli, unici sau multipli, pastrand un nivel normal de hormoni tiroidieni.

Thyroid Cancer: Metastatic Disease, How Much Radioactive Iodine. Dr. Kwak. ThyCa Conference

Este un termen enspecific care papillary thyroid cancer metastasis to bone cresterea tiroidei in talie si in greutate de cause diverse, la persoanele eutiroidiene, hipotiroidiene sau hipertiroidiene. Etiopatogenie: 1. Defectul genetic de sinteza de hormone tiroidieni, apare in gusa congenitala- hormonii tiroidieni fiind insuficienti, hipofiza stimuleaza sinteza de hormone papillary thyroid cancer metastasis to bone, cee ace implica proliferarea epiteliului follicular tiroidian cu hiperplazia secundara a acestuia.

Goatrogenii varza si conopida si unele medicamenete, interfera cu productia de hormone tiroidieni si papillary thyroid cancer metastasis to bone gusei. Gusa nodulara non toxica: este o crestere a tiroidei pe seama unei hiperplazii continute sau repretitive in raspunsul deficient de hormone secretati de glanda tiroida.

Clinic: Se observa masa cervicala ce comprima structurile din jur si determina simptome ca dispnee si disfagie; uneori poate fi prezent un nodul tiroidian hiperfunctional toxicsi se numeste sd. Plummer, iar clinic pacientul prezinta hipertiroidism. Tiroida poate fi crescuta in talie, sa ajunga pana la de grame. Se poate extinde substernal sis a determine detresa respiratorie.

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Macroscopic: - gusa difuza: glanda marita uniform de volum mai mult de 40gsimetric, cu aspect cenusiu, translucid, sticlos din cauza prezentei coloidului; - gusa nodulara — marire de volum asimetrica, cu aspect multinodular pe sectiune; nodulii au aspect brun-galbui sau brun-roscat, gelatinos, in functie de cantitatea de coloid; nodulii sunt incapsulati; frecvent se observa zone hemoragice, chistice de scleroza si de calcificare. Microscopic: Gusa difuza prezinta hiperplazie si hipertrofie difuza a epiteliului folicular, ocazional formand structuri papilare; pe masura ce afectiunea se cronicizeaza, cu episoade de stimulare si involutie administrare de iodaspectul coloid si nodular devind evident, cu foliculi dilatati chistic si epiteliu aplatizat sau cuboidal, nodulii au dimensiuni variabile si sunt separati prin septuri fibroase; frecvent se identifica zone de calcificare, scleroza, hemoragie si depozite de hemosiderina.

Two morphologic forms of goitre are distinguished: A. Diffuse goitre simple nontoxic goitre or colloid goitre. Nodular goitre multinodular goitre or adenomatous goitre. Pathogenesis of Goitre The pathogenetic mechanisms of both forms of goitre can be considered together since nodular goitre is generally regarded as the end-stage of long-standing simple goitre Fig.

Endocrine Abstracts

The fundamental defect is deficient production of thyroid hormones due to various etiologic factors described below, but most common is dietary lack of iodine. Deficient thyroid hormone production causes excessive TSH stimulation which leads to hyperplasia of follicular epithelium as well as cancer malign la plamani of new thyroid follicles. Cyclical hyperplastic stage followed by involution stage completes the picture of simple goitre.

Repeated and prolonged changes of hyperplasia result in continued growth of thyroid tissue while involuted areas undergo fibrosis, thus completing the picture of nodular goitre.

Diffuse Goitre Simple Non-toxic Goitre, Colloid Goitre Diffuse, nontoxic simple or colloid goitre is the name given to diffuse enlargement of the thyroid gland, unaccompanied by hyperthyroidism. Most cases are in a state of euthyroid though they may have passed through preceding stage of hypothyroidism due to inadequate supply of iodine.

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TSH levels are invariably elevated. In general, goitre is more common in females. Simple goitre often appears at puberty or in adolescence, following which it may either regress or may progress to nodular goitre. Epidemiologically, goitre occurs in 2 forms: endemic, and non-endemic or sporadic. Endemic goitre. Such endemic areas are several high mountainous regions far from papillary thyroid cancer metastasis to bone sea where iodine content of drinking water and food is low such as in the regions of the Himalayas, the Alps and the Ande.

Of late, however, the prevalence in these areas has declined due to prophylactic use of iodised salt.


Though most endemic goitres are caused by dietary lack of iodine, some cases occur due to goitrogens and genetic factors. Goitrogens are substances which interfere with the synthesis of thyroid hormones. These substances are drugs used in the treatment of hyperthyroidism and certain items of food such as cabbage, cauliflower, turnips and cassava roots. Sporadic non- endemic goitre. Non-endemic or sporadic papillary thyroid cancer metastasis to bone goitre is less common than the endemic variety.

In most cases, the etiology of sporadic goitre is unknown. A number of causal influences have been attributed.

Что еще мог бы он совершить. Этот безответный вопрос пробудил его от полузабытья. Он не в силах был долее оставаться здесь, будучи в таком вот взвинченном состоянии, а в городе существовало только одно место, которое обещало ему успокоение. Дрогнув, часть стены исчезла, когда он вошел в нее и ступил в коридор, и ее поляризованные молекулы на мгновение мягко облегли его тело -- словно слабый ветерок дохнул в лицо. Существовало много способов, с помощью которых он мог бы без труда добраться до цели, но он предпочел отправиться пешком.

These papillary thyroid cancer metastasis to bone the following: Suboptimal iodine intake in conditions of increased demand as in puberty and pregnancy. Genetic factors.

Dietary goitrogenes. Hereditary defect in thyroid hormone synthesis and transport dyshormonogenesis. Inborn errors of iodine metabolism. Grossly, the enlargement of the thyroid gland in simple goitre is moderate weighing up to gmsymmetric and diffuse.

Cut surface is gelatinous and translucent brown Fig. Histologically, two stages are distinguished: 1. Hyperplastic stage is the early stage and is characterised by tall columnar follicular epithelium showing papillary infoldings and formation of small new follicles. Involution stage generally follows hyperplastic stage after variable period of time.

This stage is characterised by large follicles distended by colloid and lined by flattened follicular epithelium Fig. Nodular Goitre Multinodular Goitre, Adenomatous Goitre As already stated, nodular goitre is regarded as the end-stage of long-standing simple goitre.

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It is characterised by most extreme degree of tumour-like enlargement of the thyroid gland and characteristic nodularity. The enlargement of the gland may be sufficient to not only cause cosmetic disfigurement, but in many cases may cause dsyphagia and choking due to compression of oesophagus and trachea. Since nodular goitre is derived from simple goitre, it has the same female preponderance but affects older individuals because it is a late complication laryngeal papilloma caused by simple goitre.

Etiologic factors implicated in endemic and hpv types genital warts or sporadic variety of simple goitre are involved in the etiology of nodular goitre too. However, how nodular pattern is produced is not clearly understood. Possibly, epithelial hyperplasia, generation of new follicles, and irregular accumulation of colloid in the follicles—all contribute to produce increased tension and stress in the thyroid gland causing rupture of follicles papillary thyroid cancer metastasis to bone vessels.

This is followed by haemorrhages, scarring and sometimes calcification, resulting in development of nodular pattern. Grossly, the thyroid in nodular goitre shows asymmetric and extreme enlargement, weighing gm or even more.

The five cardinal macroscopic features are as under Fig. Nodularity with poor encapsulation 2. Fibrous scarring 4. Focal calcification 5. Cystic degeneration. Cut surface generally shows multinodularity but occasionally there may be only one or two nodules which are poorly- circumscribed unlike complete encapsulation of thyroid adenoma, described below. Histologically, the same heterogenicity as seen on gross appearance is seen.

Corresponding microscopic features are as follows Fig. Partial or incomplete encapsulation of nodules. The follicles varying from small to large and lined by flat papillary thyroid cancer metastasis to bone high epithelium. A few may show macropapillary formation. Areas of haemorrhages, haemosiderin-laden macrophages and cholesterol crystals.

Vol 116 No 4 (2012): The Medical-Surgical Journal

Fibrous scarring with foci of calcification. Micro-macrocystic change. Este cea mai frecventa cauza de hipertiroidism la persoanele sub 40 de ani, are incidenta maxima intre ani si un raport de in favoarea femeilor. Etiologie: factori genetici, mecanisme imune. Are porbabil, un mechanism immunologic si obisnuit este asosciata cu alte leziuni autoimmune.

Clinic: semnele hipertiroidismului: bolnavii afectati sunt femei tinere cu manifestari enrvoase, tahicardie, transpiratii, pierdere in greutate si exoftalmie. Nivelul tireotropinei este scazut sau nesesizabil.

Macroscopic: Tiroida este marita difuz de ori, bilateral; gusa are o consistenta ferma, aspect neted si o culoare rosu-brun pe suprafata de sectiune. Microscopic: Foliculii tiroidieni sunt hiperplazici, papillary thyroid cancer metastasis to bone epiteliu cubic-cilindric si proeminente papilare fara ax conjunctiv in lumen; la polul apical al celulelor exista vacuole de resorbtie, sugestive pentru hiperfunctie metabolica a celulelor foliculare; Papillary thyroid cancer metastasis to bone este redus, cu aspect crestat festonat marginal; interstitial se gaseste infiltrat inflamator si chiar agregate limfocitare nodulare fomate din limfocite T; administrarea preoperatorie de iod determina involutia si dilatarea foliculilor, cu aplatizarea epiteliului si fibroza interstiala; - tesutul periorbital prezinta initial edem apoi fibroza in infiltrare limfocitara.

papillary thyroid cancer metastasis to bone

Celulele foliculare sunt inalte, columnare, cu nuclei amrita. Stroma este intens vascularizata si infiltrate cu limfo monocyte. The disease is more frequent between the age of 30 and 40 years and has five-fold increased prevalence among females. These are as follows: papillary thyroid cancer metastasis to bone. Genetic factor association. A familial occurrence has been observed. Autoimmune disease association. Other factors. Depending upon its action as inhibitory or stimulatory to follicular epithelium, it may result in alternate episodes of hypo- and hyperthyroidism.

The evidence in support is the intense lymphocytic infiltrate around the ocular muscles and detection of circulating autoantibodies against muscle antigen that cross-react with thyroid microsomes. Virus papiloma manusia (hpv), the thyroid is moderately, diffusely and symmetrically enlarged and may weigh up to gm. On cut section, the thyroid parenchyma is typically homogeneous, red- brown and meaty and lacks the normal translucency.

Histologically, the following features are found Fig. There is considerable epithelial hyperplasia and hypertrophy as seen by increased height of the follicular lining cells and formation of papillary infoldings of piled up epithelium into the lumina of follicles which are small. The colloid is markedly diminished and is lightly staining, watery and finely vacuolated.

The stroma shows increased vascularity and accumulation of lymphoid cells. However, the detoxifierea ficatului dupa alcool changes in gross specimen as well as on histologic examination are considerably altered if preoperative medication has been administered.

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Iodine administration que significa el papiloma in accumulation of colloid in the follicles and decrease in vascularity and height of follicular cells, while antithyroid drugs such as thiouracil cause marked hyperplasia.

Patients are usually young women who present with symmetric, moderate enlargement of the thyroid gland with features of thyrotoxicosis pageophthalmopathy and dermatopathy. Ocular abnormalities are lid lag, upper lid retraction, stare, weakness of eye muscles and proptosis. In extreme cases, the lids can no longer close and may produce corneal injuries and ulcerations.

Troidita Hashimoto Boala papillary thyroid cancer metastasis to bone autoimuna a tiroidei caracterizata prin prezenta de anticorpi ce distrug treptat foliculii tiroidieni. Frecvent ovarian cancer is treatable asociaza si alte leziuni de natura autoimuna, inclusive leziuni endocrine. Macroscopic: Glanda tiroida marita de volum de ori, difuz, simetric, bilateral; are o consistenta ferma greutate intre g, capsula intacta; pe suprafata de sectiune are aspect carnos, de culoare galben- cenusiu, palid, lobulatia este accentuate si lobii individuali proemina.

Microscopic: Interstitul tiroidian intre foliculi prezinta un bogat infiltrat inflamator limfo-mononuclear limfocite si plasmocitecu formare de foliculi limfoizi cu centru germinativ; - Foliculii tiroidieni sunt hpv dil tedavisi si redusi numeric si mici. Infiltratul de limfoplasmocite cu formarea papillary thyroid cancer metastasis to bone centri clari asemeni unui limfom nodular este proeminent iar fibroza are grade variate de extindere.

Diffuse goitrous enlargement of the thyroid. Lymphocytic infiltration of the thyroid gland. Occurrence of thyroid autoantibodies. Though rare in children, about half the cases of adolescent goitre are owing to autoimmune thyroiditis. Hashimoto, a Japanese surgeon, described it in as the first auto immune disease of any organ. It appears that TSH-receptor antibody may act both to depress or stimulate the thyroid cells to produce hypo- or hyperthyroidism respectively.

Thus, these patients may have alternate episodes of hypo- papillary thyroid cancer metastasis to bone hyperthyroidism. Genetic basis: The disease has higher incidence in firstdegree relatives of affected patients. Grossly, the classic form is characterised by diffuse, symmetric, firm and rubbery enlargement of the thyroid which may weigh gm.

Chirurgia Bucur ; 5 : They are considered to be relatively rare tumors; however, more recent studies on NET epidemiology have demonstrated an increasing incidence and prevalence over the past 30 years. Aims: We intend to compare the strategy used in a real life clinical environment in the case of pancreatic neuroendocrine tumors, as opposed to an ideal model, as presented in literature. Materials and methods: Our case series consist in 18 patients with neuroendocrine pancreatic tumors diagnosed and treated in the Surgery I department of Clinical Hospital Dr.

Sectioned surface of the thyroid is fleshly with accentuation of normal lobulations but with retained normal shape of the gland. The fibrosing variant papillary thyroid cancer metastasis to bone a firm, enlarged thyroid with compression of the surrounding tissues. Histologically, the classic form shows the following features Fig. There is extensive infiltration of the gland by lymphocytes, plasma cells, immunoblasts and macrophages, with formation of lymphoid follicles having germinal centres.

There is decreased number of thyroid follicles which are generally atrophic and are often devoid of colloid. The follicular epithelial cells are transformed into their degenerated state termed Hurthle cells also called Askanazy cells, or oxyphil cells, or oncocytes.

These cells have abundant oxyphilic or eosinophilic and granular cytoplasm due to large number of mitochondria and contain large bizarre nuclei. There is slight fibrous thickening of the septa separating the thyroid lobules. It can occur at all papillary thyroid cancer metastasis to bone including children and young verrue seborrheique papillomavirus but the incidence is higher with advancing age.